Centracare Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

375987 Issued in MN

Legal business name

CENTRACARE SURGERY CENTER

Practice address

3701 12TH St N
101
Saint Cloud, MN 56303-2255

Phone

(320) 253-7257

Fax

(320) 257-5671

NPI assigned

Aug 29, 2016

Reactivated

Sep 10, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gregory R Klugherz

Title

Vice President and Cfo

Phone

(320) 255-5665

Specialties & licenses 1

Addresses

Other names 1

• Midsota Surgical Suites Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Centracare Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Saint Cloud, MN
  • NPI 1861538613

  O20070406000176

  Same enrollment

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin S Jenner, M.D.

  • Anesthesiology Physician
  • Saint Cloud, MN
  • NPI 1508151853
  NPD
• Maria D Mallory, MD

  • Surgery Physician
  • Saint Cloud, MN
  • NPI 1689664344
  NPD
• Richard Kyle Maciver Martin, MD, FRCSC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Saint Cloud, MN
  • NPI 1902381148
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1194271239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 CENTRACARE CIR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-229-4964",
            "fax_number": "320-229-5171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 12TH ST N",
            "address_2": "101",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032255",
            "telephone_number": "320-253-7257",
            "fax_number": "320-257-5671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRACARE SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-29",
        "last_updated": "2024-09-10",
        "deactivation_date": "2024-07-31",
        "reactivation_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "KLUGHERZ",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "320-255-5665"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MN",
            "license": "375987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midsota Surgical Suites",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Centracare Health System
• Centracare Health System
• Centracare Health System
• Centracare Health Systems
• Centracare Pharmacy Services LLC
• Centracare Surgery Center, LLC
• Central Imaging LLC
• Central Minnesota Anesthesia, LTD
• Central Minnesota Couseling Center, Inc.
• Central Minnesota Dementia Community Action Network

• Ambulatory Surgical Clinic/Center in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Ambulatory Surgical Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.